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Recent Newspaper & Online Columns by Kate Scannell MD

Maintaining weight loss after dieting -- a ghost of a chance


By Dr. Kate Scannell, Syndicated Columnist
First published in print: 10/29/2011

You don't expect to read a Halloween story in the staid New England Journal of Medicine. But there it was this week -- a chilling tale about menacing hormones that kept taunting dieters to eat!

Dieters have long-suspected the presence of powerful adversarial forces laying "in weight" of any seemingly successful dieting effort. Lost pounds seem to return automatically, like cloying "boo!"-merangs.

Many dieters are dispirited by such frustrating experiences. They commonly convey a sense of feeling haunted by powerful internal messages that relentlessly coax them back to the snack table, scare them into believing they must -- and will -- return to their pre-diet weights.

Finally, Australian researchers have confirmed those dieters' suspicions. By analyzing changes in blood hormones that regulate metabolism and stimulate appetite, they've newly established why we face such a fat chance of keeping off the weight. They've discovered the existence of hungry hormonal goblins that actually linger within dieters' blood for at least 12 months after dropping pounds. These entrenched hormonal goblins tempt dieters to eat, encourage them to store more fuel as body fat, and slow their metabolism.

It has been previously known that similar hormonal changes occur soon after obese people lose weight, conspiring against their attempts to maintain the loss. We have known that caloric restriction causes abrupt reductions in the body's energy expenditures and levels of leptin and cholecystokinin, as well as simultaneous increases in appetite and ghrelin -- all of which collude to thwart the dieter and promote weight regain.

But the new study is noteworthy because it demonstrates, sadly, that these physiologic alterations do not disappear over time -- at least throughout the yearlong period in which the study's participants dieted.

The Australian study included 34 overweight people, in average of 209 pounds, who lost at least 10 percent of their body weight through supervised dieting. The first two hormonal analyses were conducted at baseline before the diet began and at 10 weeks into the study when the dieters had lost about 30 pounds each.

As expected, blood levels of the hormonal mediators that stimulate appetite and promote weight gain had changed unfavorably at the 10-week mark -- as had dieters' sense of hunger -- when compared to baseline values.

Subsequently, the dieters followed a maintenance diet for 12 months. At the conclusion of the study, they had regained an average of about 12 pounds each. They not only claimed to be as hungry as they'd been 10 weeks into the study -- they also felt hungrier than they felt before the study began.

Additionally, they experienced more intense hunger both in-between and after eating regular meals. Moreover, blood levels of the culprit hormones remained abnormal, refusing to return to their baseline.

This new study may dishearten many people hoping to lose significant weight, or anyone venturing on yet another diet. But it may also allow some frustrated dieters to feel a little saner and less self-judgmental, given the known hormonal sabotage at work.

The new findings may also promote a more compassionate and educated understanding about people who struggle so hard -- and unsuccessfully -- to lose weight.

As the researchers suggest, " ... the high rate of relapse among obese people who have lost weight has a strong physiological basis and is not simply the result of the voluntary resumption of old habits."

If the researchers' findings are replicated and confirmed (which I expect to happen), and if a genuine causal association is firmly established between recalcitrant obesity and the deranged hormonal profiles, then we may also be directed toward more accurately -- targeted and effective pharmaceutical interventions for obesity.

In turn, that may help repatriate billions of health care dollars that are currently wasted on ineffective dietary regimes. As it stands, the $59 billion U.S. diet industry -- including commercial and medical enterprises -- is a very big business with too little to showcase.

Most importantly, if more rational and effective obesity treatments do become available, the oppressive health care burden on the obese population may lessen -- less heart disease, high blood pressure, diabetes, sleep apnea, and various cancers.

In turn, we may also see significant decreases in our national health care costs attributed to obesity-related illness -- about $168 billion according to last year's study released by the National Bureau of Economic Research.

So, while the new study may put some of us in bad spirits, it also provides several hopeful messages. It's not time to give up the ghost just yet.
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Kate Scannell is a Bay Area physician and the author, most recently, of "Flood Stage."

© Copyright 2011, Kate Scannell